Friday, October 12, 2018

Simple as ABC? Not Quite

Even if you’re not sixty-five or over you can hardly help but know it’s the annual open enrollment period for Medicare just from seeing all the TV ads sponsored by insurance companies wanting to sell seniors their health care coverage.  So let’s again cover some Medicare basics.
 
Medicare is the national insurance plan for the disabled and people over age sixty-five.  It covers hospital (and other) services under Part A and physician (and other) charges in Part B.  You probably have been paying premiums for the coverage for years, even if you’re not actually covered by Medicare yet.  That’s because the FICA tax that comes out of your paycheck includes not only your Social Security system contribution but also a 1.45% tax on your earnings for hospital insurance.  So when you actually enroll in Medicare there is no further cost for Part A coverage (unless you continue to collect wages).  This is not because you saved enough in your personal account to pay for it—because there is no personal account.  Benefits are being paid the accumulated taxes and by the people still working.
 
You will have to pay premiums for Part B coverage, and that typically comes directly out of your Social Security benefits.  You must enroll for Part B when you become eligible or else pay a higher penalty rate permanently when you do enroll.  There’s an exception for those who have other qualified health insurance coverage.
 
During the last Bush administration Medicare added prescription drug coverage, referred to as Part D.  Again, enrolling when you are first eligible is critical.  But you must find a separate Part D plan to cover your drug needs.
 
So did Medicare skip over “C”?  No, Part C is what you are mostly hearing touted on TV.  Companies like Humana and United Healthcare offer what are called Part C, or Medicare Advantage, plans.  These are an alternative to enrolling in “regular” Medicare with the government.  They must cover everything regular Medicare does but almost always offer some additional benefits like vision, hearing, or dental and even include Part D benefits (drug coverage).  They may also advertise that you pay no premiums for their plan.  That’s because you will continue paying your Part B premiums to Uncle Sam who then pays the insurance company to assume the financial risk for your health care needs.
 
Medicare Advantage plans are not the same as Medicare supplement plans.  The latter are intended to cover the co-pays and deductibles of regular Medicare, which typically come to 20% or more of a beneficiary’s health care expenses.  They do not cover prescription drugs and will cost the enrollee an additional premium.
 
In very general terms, then, complete Medicare coverage can be attained in one of the following ways:
 
  • “Regular” Medicare + a Medicare supplement plan + a Part D prescription drug plan; or
  • Medicare Advantage plan
 
At first glance it looks like a no-brainer: full coverage at no additional cost above your Part B premium?  Who wouldn’t enroll in a Medicare Advantage plan?  But buyer beware.  Medicare Advantage plans will have a narrower network of providers.  That means less choice of doctors and hospitals for you.  Plus, they impose administrative burdens on the healthcare providers—like having to get pre-authorization before rendering certain types of care; or putting extra burdens on you, like having to get a referral to go to a specialist. 
 
For that reason, many providers will not join these networks.  So before signing up for a Medicare Advantage plan, thoroughly check out its network of doctors and hospitals.  Are your doctors in-network?  If not, you will probably have to find a new doctor or else pay mostly out-of-pocket.  And don’t be surprised if the biggest and most highly advertised insurance companies’ Part C plans are NOT accepted by your doctor/hospital.
 
In talking to friends, and judging by my own dad’s experience, Medicare with a supplement and Part D plan will most likely cost you less out of pocket, all things considered.
 
So make your choice wisely over the next few weeks if you’re Medicare-eligible.  Don’t take the TV hype at face value.  Check out the plans.  Talk to friends who might be enrolled in a Part C plan and see what their experience has been.  Lots of money is at stake here.  The cheapest-premium option might not be the best option for you, depending on your needs.  As I always say, run the numbers.
 
Until next time,

Roger

“Good judgment wins favor.” Proverbs 13:15 NIV®*

                                                                                                      
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